ABSTRACT
Rationale: Patients with chronic lung disease experience dyspnea and other symptoms that significantly affect quality of life and can result in elevated rates of depression and anxiety. Concomitant anxiety and depression can often result in poorer outcomes in these patients and can hinder their confidence in self-management of their disease. Mindfulness involves non-judgmental attention to a person's surroundings and experiences cultivates the ability to be aware of the present moment. A formal mindfulness-based intervention developed at Ohio State University called Mindfulness in Motion offered within the established structure of a pulmonary rehabilitation program was implemented in both virtual and in-person format to promote disease self-efficacy, reduce stress and improve symptoms of anxiety and depression that often accompany chronic symptomatic lung disease. Methods: This is a prospective feasibility/pilot study pre/post-test design with an intervention and control wait list groups. All new adult patients enrolling in pulmonary rehabilitation were eligible. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention that is offered in a group format for 1hr/week/8 weeks combined with 10-20 online audio and video programs to facilitate individual mindfulness practice. The Mindfulness in Motion program relaced one of the usual 1 hour pulmonary rehabilitation education sessions. One round of the intervention was done virtually via Microsoft Teams due to the restrictions of the Covid-19 pandemic and an additional in-person round of this program is currently ongoing. The primary outcome is the PROMIS Self-Efficacy for Managing Chronic Conditions-Symptoms. Breath counts pre and post intervention are of interest as well. Secondary outcomes are: PROMIS Percieved Stress Scale, PROMIS Anxiety Short Form, PROMIS Depression short form and Respiratory Rate. These measures were collected pre-intervention, post-intervention, 6 months and 1 year. Results: Data collection and analysis of primary and secondary endpoints is currently ongoing. However, early analysis shows a decrease in respiratory rate immediately post-intervention. In initial 4 subjects in which respiratory rate data was recorded, 3 out of 4 patients showed significant consistent reduction in respiratory rate from the beginning to the end of each session in the 7 weeks of the intervention already completed (see Table 1). Conclusion: Mindfulness in Motion is a mindfulness intervention that is implementable within the existing structure of pulmonary rehabilitation. Further, it may be effective at slowing breathing rate in these patients prior to exercising which may be beneficial to participation. Further investigation with a larger randomized control trial would be feasible and warranted for further study. (Table Presented).
ABSTRACT
INTRODUCTION AND OBJECTIVE: While primarily associated with prostate cancer pathogenesis, TMPRSS2 has recently been identified as a co-receptor for ACE2, the target protein used by SARSCoV2 for viral entry. This protein is primarily regulated by the androgen receptor, and this mechanism may partly explain the disproportionate burden of disease among males. We hypothesized that the use of androgen modulation therapies (AMT) such as 5-a-reductase inhibitors (5-ARI) and androgen deprivation therapy (ADT) may affect inpatient outcomes among hospitalized men with COVID-19. METHODS: In a single-center retrospective analysis in a large urban hospital system, hospitalized males with laboratory-confirmed diagnosis of COVID-19 and a history of benign prostatic hyperplasia (BPH) and/or prostate cancer was identified from February to June 2020. Men were then stratified by use of specific AMT (ADT or 5- ARI). Baseline patient and hospital characteristics were analyzed using descriptive statistics, and multivariable regression models were used to explore the association of AMT with inpatient mortality, length of hospital stay (LOS), and other ICU outcomes (ICU admission, ICU Length of Stay, Non-Invasive Mechanical Ventilation, Intubation, and ARDS). RESULTS: A total of 396 inpatients were identified, with 130 (32.8%) having prior use of AMT. Of these, a large majority used 5-ARI (n=122, 93.8%). Mean (SD) age of patients was higher for those using AMT (76.5 (10.7) vs. 71.1 (11.8) years;p<0.001). No significant differences were identified in AMT use by race, body mass index, smoking status, or Charlson Comorbidity Index. Despite adjustment for these factors, AMT use was not associated with ICU admission, ventilation status, length of ICU stay, or length of hospital stay. However, a non-significant trend of decreased mortality was identified with the use of AMT (adjusted OR: 0.56;95% CI: 0.29e1.02;p=0.06) (Table 1). CONCLUSIONS: Preliminary analysis suggests that AMT does not appear to improve inpatient outcomes among hospitalized males with COVID-19. The non-significant trend of decreased inpatient mortality, however, may be attributed to insufficient power. Future research with large sample sizes may uncover potential benefits of androgen modulation on COVID19 pathogenesis and outcomes.
ABSTRACT
We analyze an epidemic model on a network consisting of susceptible-infected-recovered equations at the nodes coupled by diffusion using a graph Laplacian. We introduce an epidemic criterion and examine different isolation strategies: we prove that it is most effective to isolate a node of highest degree. The model is also useful to evaluate deconfinement scenarios and prevent a so-called second wave. The model has few parameters enabling fitting to the data and the essential ingredient of importation of infected; these features are particularly important for the current COVID-19 epidemic.
ABSTRACT
BACKGROUND: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes. OBJECTIVE: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data. SETTING: NYC surveillance data from February 29 to June 12, 2020. PARTICIPANTS: Individuals tested for COVID-19 in metropolitan NYC.Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. RESULTS AND LIMITATIONS: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data. CONCLUSION: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women;this trend remains after stratification by age. J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590.